The Connected Care Team

Improving Access to Care and Transparency in Healthcare

• TigerConnect • Season 2 • Episode 15

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One of the silver linings of the COVID-19 pandemic is that it has improved healthcare delivery systems and opened the door for better patient advocacy. Brent Steineckert and Sharp HealthCare are committed to giving patients more control over their own care. Simple things like self-scheduling, mobile check-in, virtual on-demand telehealth, mobile access, and remote monitoring help advance that goal.

In this episode of The Connected Care Team, Will O’Connor, M.D. and Brent Steineckert discuss using technology to make life easier for clinicians, empowering patients, and teaching physicians the art of “webside manner.”

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Dr. O'Connor: [00:00:00] With us today, we have Brent Steineckert. He is the director of access, electronic health records and health information management for the Sharp Rees-Stealy medical group, which is part of Sharp HealthCare in San Diego, California. Welcome to the show Brent. Why don't we start today by you talking a little bit about your role at Sharp. 

Brent: Thank you, Will. I’m glad to be here.

Dr. O’Connor: Why don't we start today by you talking a little bit about your role at Sharp HealthCare. 

Brent: Yeah. So my role spans a couple areas and the way I sum it up is oversee the integration of technology and clinical [00:00:30] operations. So we're trying to find tools and ways to make the lives of our physicians, nurses, advanced practitioners and staff, easier through the incorporation of technology, but at the same time, I'm trying to improve access to care for our patients, make it more convenient, easily accessible, uh, and also more timely.

Dr. O'Connor: Talk a little bit more about what you said at the start. As far as making physicians, nurses, other healthcare [00:01:00] workers lives better. How, how are you doing that? And that's something so important, uh, today with everything that we have going on, how are you going about doing that? 

Brent: Yeah. Well, when you, when I round in our clinics and hospitals and talk to physicians and nurses, you know, the thing that comes up a lot is the, this feeling of burnout. Right? And it's something that you've heard about a lot in the press and there's been studies on it and all kinds of surveys. And the trend is the, you know, [00:01:30] just to boil it down is physicians and nurses, you know, love taking care of patients.

They love, um, helping improve lives. They love preventing harm, um, getting patients the care they need in the time they need it. But they don't love so much as you know, all the paperwork and bureaucracy that goes around that, uh, you know, trying to decide, orchestrate the authorization process to see if a patient can even get an appointment or a particular medication.

All those activities are things that add to the burden [00:02:00] of our clinicians and what contributes to burnout. So part of my role is to really look for ways to offload all of that bureaucratic work, that administrative work into systems that can do it either automatically through intelligent, uh, processing or batching or, uh, you know, part of what I want to talk a little bit about today is empowering the patient to do some of this work because not only do they want to do [00:02:30] it, but by doing it themselves, they actually will have better health outcomes and better knowledge and control over their own healthcare.

Dr. O'Connor: That's interesting. So you're empowering the patient as, as part of this. Talk about that a little bit more because typically the, the willingness of patients historically, to participate in things like this has been less than ideal. 

Brent: Yeah. And that's one of the silver linings of the pandemic [00:03:00] is that it has forced both the healthcare delivery systems and opened the door for patient advocacy in terms of allowing them to do more interactions with the healthcare system have more control over simple things like self-scheduling, mobile check-in, virtual on-demand telemedicine, um, mobile access, remote monitoring.

All of these tools have really been accelerated in the course of the last a year or two. And we have a tagline here [00:03:30] that we’ve been sort of unofficially, uh, talking amongst ourselves, which is our goal, uh, over the next couple years is to empower the most underutilized member of the care team, the patient. And some of the things that we really want to see take flight with that are really giving the patient transparency to their health information. Recent legislation with, uh, the information blocking act that came out in the last year.

[00:04:00] are almost requiring this by law where in the old days, you know, one of my favorite Seinfeld episodes is where, you know, Elaine has to go around and try to get her medical record and they refused to give it to her because you know, somewhere in there is written that she's a difficult patient. And she goes to all ends to find it, right?

That was the old world. The new world, and what you'll see reflected in a lot of the startup companies that are entering the healthcare space is this world of transparency where not only do you have access to your own medical information, [00:04:30] but you can do with it what you want. So you can take it, download it to your device.

You can share it with your family or caregivers. You can share it with a physician or a specialist to whom you're with you're seeking care. Um, and, and it's really changing the dynamic of the healthcare system or the physician even being the owner of health information. Put translating that to the patient, being the owner, similar to what we saw in other industries like finance [00:05:00] banking, um, travel of course, um, things like that.

Dr. O'Connor: You know, I think transparency and access is a, is a big part of this. Um, and I think you're right, that has been one of the silver linings of the pandemic, but how do you replace that in room interaction? That, that emotional connection that happens between the patient and the character? 

Brent: Yeah, and that is the billion [00:05:30] dollar question. And where I see as the untrodden lands of the future for digital health care. So you talk to any healthcare system in the nation, and they'll talk about digital front doors and chatbots and self-scheduling, and they have all the tools, uh, or most of them do, or a lot of them do.

And they're well underway to deploying those tools. But what's missing is exactly what you just hit upon was, how do you [00:06:00] deploy those tools in a way that brings your culture and your brand into the interaction? How do you bring emotion into a secure message? Right? Like how do you convey the same sense of caring and empathy in a virtual telemedicine visit that you do in an exam room visit?

And we have, uh, you know, we've been using the term: website manner. And we actually had a CMI certified [00:06:30] course that we taught to all our physicians on website manner. And it was physicians teaching other physicians how to bring empathy and listening and caring into a virtual encounter as well as how to convey some of those same principles in asynchronous encounter.

Meaning something like where you're messaging a patient or, or, uh, doing, uh, a secure message of some types through the portal.

Dr. O'Connor: Yeah, that, that, that is interesting. I think it's, it's certainly [00:07:00] worthy of the attention you’re, you're giving it. I like that term website manner and, and developing around that. It's certainly not a natural skill for physicians and other, other caregivers to, um, to have. Talk to me a little bit more how you're doing that over, over messaging. You're you are using, uh, reaching out directly to patients over, uh, text messaging, direct messaging? 

Brent: Yeah, for some of our population health [00:07:30] programs with patients who have chronic illnesses, we do text messaging, which is coordinated by their nursing care team. So they, uh, send patients, you know, not only reminders, but just they ask, how are you doing? And, you know, that’s really interesting. The responses that we get from patients who, for the most part, you know, they're very mindful of, you know, they're, they're in this mindset of, I don't want to waste your time with my problems kind of a thing.

And, [00:08:00] but by doing this, that kind of outreach in a really frictionless way, it allows our population health teams to act early. If they detect that maybe a patients, you know, depression is perhaps starting to spike a little bit or, or maybe there's a fall risk situation or a medication adherence issue where they're not taking their meds as directed that could lead to a more serious outcome.

So those making the kind of the two tenets of [00:08:30] what I would focus on are if, when you're deploying digital tools in the healthcare space, number one, reduce the friction as much as you can. Right? So make it easy for patients to access. Um, that does mean having, you know, what you'll hear referred to as an omni-channel presence where it's not just one method, but it's a variety of methods, but tie those methods together so that whether I'm making a phone call or responding to a text message or responding to a [00:09:00] secure message through the patient portal, the people I'm responding to know what the other is saying. And that's a part that I think is missing in some of the delivery of this today. The second tenant is the emotional piece and you know, there's a lot of research that shows the more emotionally connected to an app a consumer is, or in this case, a patient, the less likely they are to delete it.[00:09:30] 

Right. So it talks about why patients sometimes keep their Fitbit app long after they've stopped tracking their steps or what not. They just, they feel like a connection to the health and wellness activities. And so part of that new frontier of what we're trying to do is, is create that emotional connection.

I'll give you one simple example, like something we're probably all familiar with it. At some point you've probably had to either fill out a form of some type, either for a, you know, in [00:10:00] healthcare, a lot of times it's your, your screening form or your, your physical wellness assessment form or an intake form for a specialty consultation.

You know, when was the last time you were thanked for filling out that form? You know, when was the last time, you know, you showed up to a front desk and they checked you in and they said, you know, Dr. O'Connor, I really want to thank you for completing this online. It's, you know, it's really helped us, uh, queue up for your visit today.

Um, we saw that, you know, you're on these medications. Don't worry, we're [00:10:30] gonna get those refilled for you. Uh, we also saw that you have, you know, a family history of this genetic thing, so we're gonna make sure we cover that today and, you know, just thank you. Like, I, it just hasn't happened. And so just something as simple as that can sort of bridge that emotional tie.

The other, the other one final, uh, or one example I'll cover is one of our physicians and it goes to transparency and emotional connection. So one of our physicians, Dr. Tommy Korn is a, uh, eye surgeon [00:11:00] here at Sharp Rees-Stealy. He actually puts in his consultation notes and progress notes, little personal encouraging reminders for patients.

And it could be something as simple as you're doing a great job with the, uh, doing the eye drops and the post-surgery recovery. Enjoy your vacation next week. And, and I'm looking forward to seeing you in three months. You know, he puts some of the stuff in every one of his [00:11:30] notes. And since we're doing the open notes, uh, collaborative, where we share essentially every progress note with our patients securely, patients actually see that, and he gets a lot of positive comments from his patients. And I know, I happen to be one of his patients. So I see what he puts in there for me. And it is, you know, whereas I, maybe wouldn't be super excited to go read a progress note of, uh, uh, of a visit that I just went to, I look forward to reading his [00:12:00] notes, cause I know he puts little nuggets of encouragement in there for me. And I'm always curious to see what he says.

Dr. O'Connor: That's interesting, no it's certainly a good use of that technology, and it sounds like he's doing a good job connecting to his, his patients in a little bit of a different, of a different and advanced way. Talk to me a little bit about how you're coordinating care in this type of environment. It's certainly, it's one thing to reach out to the patient, but then as you mentioned earlier, [00:12:30] keeping all of these people, uh, connected, um, and communicating and making sure that they are coordinating care for the, for the patients properly. How are you going about doing that?

Brent: It's with a lot of difficulty is sort of the short answer. Uh, but the longer answer, we're doing it by being very focused. So we're not attempting to do everything all at once, but we're being very thoughtful about [00:13:00] what we're starting with. So in terms of our patient engagement tools, you know, we, we stood up a digital front door and our, our chief marketing officer, um, Jim Nuckols, he's, uh, he's got a great vision that he, he says almost at every meeting he wants to make Sharp the most convenient healthcare system in the universe. And so part of that is by standing up these digital tools that are well-defined, they don't do everything, but they [00:13:30] do a small subset of things really, really well. So if you want to choose a doctor, you want on-demand virtual urgent care, or you want to go to one of our EDS, emergency departments, urgent care centers, all of that sort of amalgamated in one presentation. So you can see urgent care wait times you can see emergency room wait times if you wanted to do an on demand visit, it's kind of like an OpenTable concept. If you ever use OpenTable to make a reservation where you just, you [00:14:00] click and you see the available dates and times without needing to log in, and then you select the time and date you want.

And then, it books, you into that visit. So that's part of that friction-free piece. So since we're a little focused in that regard, it allows our teams to, to really connect with each other. So, so what that means is even though the patient is scheduling self scheduling, our teams who do the manual, scheduling are aware of that happening, and they [00:14:30] have access to the dashboards and the tools that show live what's happening. 

So if a, let's say a patient were to call and say, Hey, I tried to do a virtual urgent care visit and, and I booked it, but I, you know, I don't know what to do. They can go right in there, say yes, I see, you know, you're scheduled at two o'clock. Here's how it’ll work. Let me test your microphone and camera out right now to make sure you're good to go.

And then boom, hand them off to that visit. And it's a, it's a term we're starting to [00:15:00] refer to as like a digital concierge. So our scheduling services, our contact center, our, even our front desk staff are becoming less of reception services and schedulers, and they're sort of evolving into this digital concierge concept.

Um, and that's something that, um, I'm really excited about for the future.

Dr. O'Connor: In an environment where there's an increasing level of complexity for patients and things often can get missed. [00:15:30] How are you doing efficient care handoffs in your environment? 

Brent: We interviewed hundreds of patients over the last several years. And one of their pain points was, you know, we did a great job at the individual visit level, but when it came time to go from one visit to the next, you know, whether it was a specialty consultation or advanced imaging, or maybe some, some other [00:16:00] ancillary type testing or therapy, sometimes the communication processes weren't as well, honed as we would like them to be. And the patient would have to repeat their story and say, you know, explain why they're there. And that just wasn't a great experience. And so we invested a lot in technologies and workflows that support that handoff and care continuum. So for example, you know, our, our on-call physicians [00:16:30] use TigerConnect to communicate with each other when they're transferring patient care. So for example, if I'm a primary care physician and I have a need for a cardiology consult for a patient who I can tell is really worried, I can easily from my mobile device or desktop just message, the on-call cardiologist without even knowing who, who they are and say, Hey, I'm going to send a patient to you. And here's, here's kind of the deal. And that way, when that patient [00:17:00] shows up or interacts with that receiving department, that specialist, they already have a leg up, they know why the patient's coming in.

They know who's referring them, they kind of know the backstory. And so it just makes that experience so much better. I mean, just imagine, you know, as a patient, it's better to hear: Hey, uh, Dr. O'Connor we've been expecting you. We're glad to see you. Thank you for coming to see us versus Hey, Dr. Connor, can you tell us why you're here today?[00:17:30] 

Dr. O'Connor: Right. That warm handoff feels so much better. It's like, Hey, I talked to Dr. So-and-so, here's what they said about you. Here's what they think and here's what we're going to do to get you taken care of. Right. It just, it feels so much better for the patient.

Brent: And it's so friction-free because it's, you know, it's essentially a text message is what they're doing. And, and physicians are already are familiar with the text messaging concept. It's, it's super easy. The sort of the ubiquity of access makes it, whether it's mobile device or desktop or whatever, makes it really easy for both the [00:18:00] sending physician and the receiving physician to communicate, ask each other questions.

And then, you know, after the specialty consultation, it goes, potentially goes back to the primary care physician where the specialists, if there's an urgent need, may send the primary care a message and say, Hey, here's what I'm going to do for your patient. I just want to keep you in the loop or if it's less urgent, you know, they make just send them a copy of their consultation note.

Dr. O'Connor: Wow. Well, it sounds like you've, you've done an amazing job, um, [00:18:30] setting up an IT infrastructure in order to enable this type of care. Any, any outcomes from this, this work that you've been tracking, any clinical or financial outcomes? 

Brent: Yeah. And I, you know, for other health care leaders out there, I would say this, this idea of connecting the emotional aspect of self and self service and patient engagement is an untapped gold mine to achieve the triple lane, in particular reducing costs. [00:19:00] Uh, so just take something as simple as self-scheduling or even self check-in, you know?

It’s not super exciting. It's not the flashy, you know, shiny object, the MacGuffin that gets everybody excited. But, you know, when you're doing several million visits a year, like we are just moving the needle a few percentage points on self-scheduling can save an organization, hundreds of thousands, if not millions of dollars [00:19:30] in costs.

And those costs can be reinvested in the development of what I was referring to previously that digital concierge type. Uh, interactions that really maximize the, both the tools you have deployed and the handoff that occur between different parts of the healthcare system. The other part of it is, is patients will choose their provider and healthcare system, especially patients these days, based on the availability of some of these [00:20:00] tools.

And not, uh, quality is assumed, you know, when patients are physician shopping, but the patients don't necessarily want to have to call a call center and go through a phone tree when they're just trying to get a primary care physician, they want to see, okay, if this person looks good and my friend referred me to them, or I heard good things about their healthcare system.

Oh, look, they have an appointment available tomorrow. At two, I could book it right now. I mean, [00:20:30] that’s kind of the consumer driven mindset we're in today that healthcare systems really have to adapt to, or, you know, potentially they risk leaving a lot on the table.

Dr. O'Connor: Yeah. Yeah. Well, Brent, I really appreciate you sharing your perspective with us today and congratulations on all your success at, uh, Sharp. It sounds like a great place to be a patient or a, uh, a provider. So really appreciate your time today. Thank you. 

Brent: Thank you for having me. It's a pleasure.